Healthcare Provider Details

I. General information

NPI: 1184288045
Provider Name (Legal Business Name): IFEOMA ERICA OBUMNEME-AKANEME
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 04/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 STEVENS AVE STE 4
MOUNT VERNON NY
10550-2543
US

IV. Provider business mailing address

1136 E 224TH ST
BRONX NY
10466-5835
US

V. Phone/Fax

Practice location:
  • Phone: 718-219-1703
  • Fax:
Mailing address:
  • Phone: 718-219-1703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF344321-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: